"Dax's Case" Autonomy and Paternalism

Publication ID Published Volume
785 April 21, 2008 4


One of the most important assumptions of patient-centered ethics (and narrative ethics) is that one cannot do justice to a case without knowing all of the social, economic, religious, and psychological factors that may influence the process. In other words, a good decision depends on more than medical expertise. In this patient-centered ethics case, students complete four prereadings prior to class which begins with a five-question pretest. The large group then watches 38 minutes of the video "Dax's Case," available for purchase, before breaking into small groups for 2 hours. During this time, learners reflect on the perspectives shared in the video, practice writing an ethics consultation note, and share them with their small group. This video and case have been used for 15 years, initially with first-year medical students, but due to the very graphic nature of the video, it is now used during the third year, when students are better prepared.


Spike J. "Dax's case" autonomy and paternalism. MedEdPORTAL Publications. 2008;4:785. http://doi.org/10.15766/mep_2374-8265.785

Educational Objectives

By the end of this session, learners will be able to:

  1. Identify decision-making capacity.
  2. Identify a patients' right to refuse treatment.
  3. Identify paternalism, and when it is justified.
  4. Identify patient autonomy.


  • Paternalism, Treatment Refusal, Dax's Case, Burns, Jehovah's Witnesses, Right to Refuse

Prior Scholarly Dissemination

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ISSN 2374-8265